AB0939 Psoriatic arthritis related fatigue: what is the magnitude of this problem and what are the correlated factors? A cross-sectional study.
Authors: A. Martins, D. Santos Oliveira, F. R. Martins, B. Samões, R. Nicolau, F. Oliveira Pinheiro, M. Rato, S. Pimenta, M. Bernardes, L. Costa
Journal: Annals of the Rheumatic Diseases (2022)

Background Fatigue is a common constitutional feature and has a significant impact on quality of life in patients with chronic inflammatory rheumatic diseases, such as psoriatic arthritis (PsA). It is a complex phenomenon and its pathogenesis remains unclear. Despite being a common symptom, it is largely ignored and rarely assessed in clinical practice. Objectives This study aims to evaluate the incidence and severity of fatigue in PsA patients under biological agents and to assess the influence of several clinical and demographic features on PsA related fatigue. Methods We conducted a cross-sectional study including patients with PsA, according to CASPAR criteria, treated with biological agents, from our University Hospital and registered in the national database (reuma.pt). Fatigue was assessed by a 13-item self-administered questionnaire (Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F]). Data collected and analyzed included: demographic data, disease activity data, functional status, comorbidities and therapies. Student’s t-test, ANOVA and Pearson’s correlation were performed to compare data, as appropriate. A p-value &lt;0.05 was considered statistically significant. Results 60 PsA patients were included, 61.7% were males, with a mean age at diagnosis of 38.1±10.5 years and a median disease duration of 13.0 (8.75-19.25) years. Most of the included patients had a predominant polyarticular pattern (n=33, 55.0%). The mean FACIT-F score was 34.48±11.61. No differences were found in the FACIT-F score according to gender, pattern of joint involvement , presence or absence of cutaneous involvement, nail dystrophy and/ or dactylitis. Patients with depression and enthesitis exhibited a lower FACIT-F score (p=0.017 and p=0.007, respectively). Patients treated with tofacitinib had a lower FACIT-F score than patients treated with adalimumab (p=0.025). No differences were found among the other biological agents. Patients in remission (according to EULAR response criteria) had a higher FACIT-T score than patients with moderate disease activity (p=0.032). In patients with a predominant axial involvement, inactive disease (according to ASDAS) was associated with a higher FACIT-T score, when compared to very high disease activity (p=0.02). Also, patients with moderate disease activity had a higher FACIT-T score than patients with very high (p=0.003) and high (p=0.008) disease activity. FACIT-F showed a significant correlation with disease activity scores as BASDAI (r=-0.546, p&lt;0.001), DAS 28 CRP (r=-0.506, p&lt;0.001), CDAI (r=-0.672, p&lt;0.001), SDAI (r=-0.641, p&lt;0.001) and ASDAS CRP (r=-0.500, p&lt;0.001). FACIT-F was also correlated with BASFI (r=-0.598, p&lt;0.001), HAQ (r=-0.701, p&lt;0.001), BASMI (r=-0.431, p&lt;0.001) and MASES (r=-0.401, p&lt;0.001). The authors found strong correlations between FACIT-F and HADS domains (Depression and Anxiety domains; r=-0.850, p&lt;0.001 and r=-0.748, p&lt;0.001, respectively). A strong correlation was also found between the FACIT-F and the 8 domains of health of the SF36 (p&lt;0.001). Conclusion Fatigue was a common symptom in our sample of PsA patients and, its magnitude was closely related with disease activity, physical function, depression and anxiety status, indicating its multifactorial nature. We can speculate that achieving disease remission could significantly alleviate the fatigue intensity and vice versa. As recommended by EULAR/ACR task force in 2008, fatigue should be measured in clinical practice and should be part of the multidisciplinary approach, in addition to controlling disease activity. Disclosure of Interests None declared